(PS6-D86) Examining Ethnoracial Differences in Retention in Evidence-based Treatments for PTSD Secondary to Military Sexual Trauma

Improving and expanding mental health treatment for veterans who have experienced military sexual trauma (MST) is currently a top priority in VHA (Holliday et al., 2020). Many of these Veterans develop posttraumatic stress disorder (PTSD), and there is increasing recognition that diversity is a core consideration in improving treatment for veterans who have experienced trauma (Livingston et al., 2020; McClendon et al., 2020). As such, more information is needed concerning the relationship between trauma-focused treatment attrition and ethnoracial identity in Veterans who have experienced MST.

This paper presents two studies exploring dropout from a Midwestern VA PTSD clinic in samples of Veterans who experienced MST. These studies aim to reduce this knowledge gap by contrasting Black and White Veterans’ retention in trauma-focused care. In study 1 (n = 141), we examined ethnoracial differences in dropout in a cohort of treatment-seeking Veterans who experienced MST and engaged in cognitive processing therapy (CPT) in a VA specialty PTSD clinic. In study 2 (n = 109), we explored the same questions related to treatment attrition in a separate cohort of treatment-seeking Veterans who experienced MST and engaged in prolonged exposure (PE) in a VA specialty PTSD clinic.

Results from both studies do not indicate ethnoracial differences in attrition rate (for both total sessions and an 8-week minimally adequate care [MAC] window) across evidence-based PTSD treatment. In study 1, with respect to total number of sessions, there was no significant difference between the Black (n = 40, M = 9.38, SD = 4.7) and White (n = 101, M = 9.29, SD = 4.1; t(139) = 0.11, p = .913) groups. Similar results were observed between Black (M = 6.63, SD = 2.24) and White (M = 6.77, SD = 2.10, t(139) = -.37, p = .713) Veterans during the 8-week MAC observation window. In study 2, with respect to total number of sessions, there was no significant difference between the Black (n = 32, M = 6.56, SD = 4.10) and White (n = 77, M = 7.38, SD = 4.13; t(107) = -0.11, p = .344) groups. Similar results were observed between Black (M = 5.50, SD = 2.41) and White (M = 5.96, SD = 2.51, t(107) = -0.88, p = .379) Veterans during the 8-week MAC observation window.

While the results from study 1 (CPT) and study 2 (PE) do not point to ethnoracial differences in attrition rates across evidence-based PTSD treatments, it remains important to consider the impact of racial and cultural factors on retention. For example, exploring whether racial stress and trauma are related to index traumas or chronic stressors may foster increased insight and provide important insight into challenges clients face. These considerations serve multiple purposes, including encouraging clinicians to foster a broad understanding of the functional impacts of PTSD and focusing on person-centered and flexible delivery of evidence-based treatment principles, both of which have been identified as key features of retention in evidence-based PTSD treatments (Kehle-Forbes et al., 2022).  Future research should aim to recruit a larger racially and ethnically diverse sample to explore possible varying retention outcomes of CPT and PE for MST-related PTSD.